Ortho Introduction
Source of symptoms relates to _____ and cause of symptoms relates to _____
structures
movement
What is derangement vs dysfunction?
derangement: anatomical disruption or displacement, centralization, rapidly changing
dysfunction: can have ANR, end range stress of shortened structure
What are 4 Movement System Impairment (MSI) interventions?
corrective exercises, movement re-education, application to daily activities
What is the stomatognathic system?
Mouth, jaws, tongue, teeth, lips, inner ear, salivary glands
muscles of mastication
What is the idea alignment of the scapula?
vertebral border parallel with the spine
vertebral border ~3in from midline
superior angle ~T2
inferior angle of ~T7
flat on thoracic and rotated ~30 anteriorly
Evidence supporting that spinal manipulative therapy shows pain relief via inhibition of what?
dorsal horn c-fibers that are local to the targeted level
When is the repeated flexion principle used?
used for patients with dysfunction and ANR
-downwardly rotated scapula
-clavicle angle less than normal
-scapula does not achieve 60degrees upward rotation, correction decreases symptoms
-short rhomboids, lat dorsi, pec, levator scapula, deltoid, supraspinatus
-weak SA, weak low trap
-rhomboids may be painful when strength testing
Downward rotation
What ligament limits excessive mandibular opening?
Forefoot varus is ______ of forefoot on rearfoot
inversion
What therapy technique may help 'refresh' the divisions of somatosensory smudging?
Manual therapy
What is postural syndrome?
End range stress of normal structures, symptoms are resolved with positional changes
Name the 4 humeral impairments of MSI
Anterior glide
superior glide
shoulder medial rotation
glenohumeral hypomobility
What is TMJ occlusion? What is it dependent on?
jaw closed, teeth in full contact, dependent on teeth position & shape
What can somatosensory smudging, central sensitization, and peripheral sensitization cause (4)
decreased inhibition by higher centers
increased stimulation of nociceptive signals
lower thresholds for firing
increased pain-related fear
What is tensegrity?
Balance of discontinuous compression elements connected by continuous tension forces
What is a positive prognosis for potential McKenzie Patients?
directional preference
What scapular MSI category would this presentation fall under:
vertebral border >3in from spine
axillary border of scapula protrudes laterally
1:1 scapulohumeral rhythm
short pec major and minor
long & weak trap and rhomboid
Scapular ABduction
What are the arthrokienmatics for opening and closing of the jaw?
Convex condyle moves across the Convex articular eminence
the intra-articular disc compensates for joint incongruence
PNE- can be modified for acute and chronic pain
CFT- for LBP
GE - chronic pain
What are the 3 types of Mulligan movements?
Natural apophyseal glides (NAGs)
Sustained natural apophyseal glides (SNAGs)
infection
fracture, dislocation, instability
cauda equina
bone weakening
vascular abnormalities
advanced diabetes
What shoulder MSI classification would medial rotation fall under with this presentation:
shoulder elevation w excessive medial rotation
short medial rotators (teres major, lat dorsi, pec major)
weak lateral rotators
Medial rotation
What stage of TMJ disc dysfunction is reciprocal consistent click (later on opening, earlier on closing); most pain
stage 3
Name the cranial nerve screen tests
II optic
III, IV, VI occulomotor, trochlear, abducens
V trigeminal
VII facial
VIII vestibulocochlear
IX, X swallowing
XI spinal accessory
XII hypoglossal
II - confrontation testing
III, IV, VI - H test
V - facial sensation
VII - symmetry of smile/frown
VIII - past pointing or marching in place
IX, X - palpation or report
XI - shoulder shrug MMT
XII - tongue protrusion